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    Heavy Periods with Blood Clots: Should You Get Worried?

    Updated 23 April 2020 |
    Published 06 December 2018
    Fact Checked
    Reviewed by Dr. Anna Klepchukova, Intensive care medicine specialist, chief medical officer, Flo Health Inc., UK
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    Are heavy bleeding and menstrual clots normal or the sign to see your therapist? Find the answers in the article below.

    What is menorrhagia?

    A lot of women suffer from heavy menstrual bleeding but time comes when it is no longer your normal heavy flow and has become too heavy for you to handle. Whenever you notice this you should think about menorrhagia. 

    Menorrhagia is the increased menstrual blood loss (defined as >80mL/cycle). In reality, menstrual blood loss is rarely measured. And very often only these women who have developed heavy menstrual bleeding interfering with life visit their healthcare providers. 

    What causes heavy periods and abnormal bleeding?

    In girls, pregnancy and dysfunctional uterine bleeding (DUB) are likely to cause abnormal bleeding.

    As the age increases, you should also think about IUCD (intrauterine contraceptive device), fibroids, endometriosis, adenomyosis, pelvic infection, polyps, hypothyroidism.

    In perimenopausal women, consider endometrial carcinoma. General bleeding problems such as von Willebrand's disease (vWF) may be the cause as well. 

    It is an abnormal thing if you have to use 2 or more pads within two 2 hours. 

    Heavy bleeding can also be related to the following issues:

    Dysfunctional uterine bleeding (DUB). This is a heavy and/or irregular bleeding in the absence of recognizable pelvic pathology. It is associated with anovulatory menstrual cycles. Anovulation is a medical term for the situation when the ovaries do not release an oocyte ( “egg cell”) during a menstrual cycle. Therefore, ovulation does not take place.

    Complications in pregnancy. Heavy periods can be due to a miscarriage and it can also be as a result of an abnormal location of the placenta (placenta previa). 

    When should you see a doctor for heavy bleeding?

    You should call the attention of your doctor when you notice one or some of the following symptoms:

    • Extremely heavy menstrual bleeding from the vagina which soaks one tampon at least within the space of two hours.
    • Irregular vaginal bleeding. Always take note of when you begin to notice bleeding in between periods.
    • Vaginal bleeding after menopause.
    • Passing blood clots that are larger than a quarter.
    • Severe cramping that comes with very heavy blood loss.
    • Iron deficiency anemia symptoms.

    Diagnosis and treatment for abnormal bleeding

    Treatment of menorrhagia is possible once your doctor is aware of the condition.

    Your doctor will most definitely ask of your medical history if you are an adult. This is most likely because if it were an adolescent, his or her first guess would be anovulation due to her age.

    He or she may recommend you for some test procedures after he or she must have told you to keep tabs on your menstrual cycle. These tabs or notes will now help the doctor during diagnosis.

    Some test which might help to diagnose menorrhagia include:

    • Ultrasound or laparoscopy. These tests due to its imaging abilities help to show the image of your uterus, pelvis and ovaries using sound waves/ direct visualization and so can help detect abnormalities if spotted.
    • Pap smear/test. This test works with the collection of cells from your cervix. These cells are tested to look out for inflammation or an infection around the cervix which may be cancerous and so lead to heavy bleeding when you menstruate or irregularly.
    • Blood tests. Your doctor takes your blood sample and checks if there is a case of iron deficiency in your blood due to Anemia and some other problems like blood-clotting anomalies and thyroid disorder (TFT- thyroid function test). 
    • Endometrial biopsy. A tissue sample of your uterine wall might be taken to a pathologist by your doctor in order to know why it keeps shedding blood.
    • Further tests such as hysteroscopy, sonohysterography, etc. depending on what the previous set of tests would show.
    Possible treatment ways:
    • Progesterone-containing  IUCDs should be considered 1st line therapy for those wanting contraception. They reduce bleeding by up to 86% at 3 months, 97% at 1 year. They are effective in dysfunctional uterine bleeding and reduce fibroid volume after 6-18 months use.
    • Tubal ligation, compared with IUD insertion, is generally associated with higher rates of menstrual-related side effects.
    • 2nd line recommended drugs are fibrinolytics (reduce blood loss by  49%) eg tanexamic acid , antiprostaglandins (reduce bleeding by 29% eg mefenamic acid.)
    • 3d line recommendation is progesterons.
    • Endometrial resection is suitable for women who have completed their families and who have <10-week size uterus and fibroids < 3 cm.
    • Ablation is now commoner than hysterectomy in the US for menorrhagia.
    • Uterine artery embolization or myomectomy is for women wishing to retain fertility who have fibroids >3cm.
    • Hysterectomy for women not wishing to retain fertility, with a uterus > 10 week size and fibroids>3cm (vaginal hysterectomy being the preferred route).

    Possible consequences of menorrhagia

    Menorrhagia is a condition so extreme that you shouldn’t take it for granted. Here’s what your doctor might tell you about the consequences of playing ignorant.

    • Anemia. It is an obvious consequence. Losing more blood than you replace every month will cause you to turn pale to the whims of anemia before long. This happens in two forms. Blood loss leads to reduction in the number of red blood cells being circulated. This turns you pale and also reduces hemoglobin which helps in oxygen transportation to tissues.

    Now when it comes to iron deficiency anemia, you find out that this occurs in the bid for your body to replace the red blood cells it lost by using up your body’s stored up iron to produce hemoglobin that will help transport oxygen to your body tissues. This causes iron depletion.

    • Severe dysmenorrhea. Menstrual cramps come naturally with your periods and therefore causing you to witness painful menstruation. But menorrhagia makes dysmenorrhea look like an amateur when it comes to causing painful cramps because then it becomes so severe due to heavy menstrual bleeding with clots larger than a quarter that you might need to be evaluated medically. 

    Nobody wants to live through this much pain, you definitely don’t want either. So make sure you’ve got timely medical help. 

    History of updates

    Current version (23 April 2020)

    Reviewed by Dr. Anna Klepchukova, Intensive care medicine specialist, chief medical officer, Flo Health Inc., UK

    Published (06 December 2018)

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